Background: Epidural steroid injections (ESIs) are a common method for treating lower back
pain, which is one of the most prevalent health-related complaints in the adult U.S. population.
Although the safety of CT-guided ESIs has been extensively studied in adults, there is limited data
concerning the procedure’s safety profile in an older patient population.
Objective: This retrospective study analyzed safety data among a single-center cohort of patients
> 65 years-old who received one or more CT-guided interlaminar ESIs from 2012 to 2015.
Study Design: An Institutional Review Board (IRB)-approved retrospective chart review.
Setting: University hospital center.
Methods: A total of 688 CT-guided ESI procedures were evaluated and a linear regression analysis
was conducted to examine the relationship between dose length product (DLP), body mass index
(BMI), procedure duration, and kVp/mA settings. Further analysis was performed on a sample of
long procedure time, average-DLP and high-DLP procedures.
Results: Average age was 75.77 years, with 44% having a BMI > 30. The mean DLP was 55.58
mGy x cm and the mean procedure duration was 5.94 minutes. All procedures were technically
successful and no complications were observed during or after any of the procedures, including at
one-month follow-up office visits. The kVp and mA settings were the strongest predictors of DLP,
followed by procedure time. The high-DLP cases had a greater number of needle placement series,
more intervertebral disc spaces included in each planning series and higher machine settings (kVp
120; mA 87.5) than the average-DLP cases (kVp 100; mA 49.9).
Limitations: This study is limited by its retrospective design.
Conclusion: CT-guided interlaminar ESIs can be performed safely, with low procedure times,
relatively low DLP’s and without complications in an older patient population.
Key words: Epidural steroid injection, interlaminar approach, CT-guidance, older adults, back
pain, lumbar spine, thoracic spine, cervical spine, dose length product, radiation exposure
Predictive Factors of the Effectiveness of Caudal Epidural Steroid Injections in Managing Patients With Chronic Low Back Pain and Radiculopathy